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Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 584 - 584
1 Oct 2010
Burke S Bergin D Kearns S Keating C
Full Access

Ankle intra-articular pathology after acute injury is common and often under-diagnosed. While the majority of soft tissue injuries improve with rehabilitation, up to 40% of patients experience chronic pain, stiffness or instability. MRI is increasingly used in the investigation of such patients; however interpretation of MRI findings requires specialist expertise. The aim of this study was to determine the diagnostic potential of magnetic resonance imaging (MRI) compared to ankle arthroscopy.

Forty consecutive patients presenting with ankle pain of at least three months duration were included in the study. This cohort of patients underwent magnetic resonance imaging (MRI) and then arthroscopy.

Pre-operative MRI reported findings were compared with the arthroscopic findings. The sensitivity, specificity, positive and negative predictive value of MRI for diagnosing ankle pathology was then assessed. The 2 senior authors reviewed the MRI scans and their findings correlated.

The average time between injury and presentation to our service was 2.2 years. This interval ranged from 3 months to 10 years. 51% of patients gave history of inversion and/or plantar flexion injuries. 14 % had symptoms, which persisted following an ankle fracture. At arthroscopic evaluation 23 patients had osteochondral defects and 37 had evidence of synovitis. MRI identified 50% of the osteochondral defects with sensitivity 50% and specificity 100%. Synovitis was not identified in any of the patients on preoperative MRI but 33% of the preoperative MRI did demonstrate a joint effusion.

Despite the high rate of discordance between MR imaging and arthroscopy in our study MRI still remains a useful adjunct in the investigation of ankle pain. The implications for practice and further study are discussed.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 48 - 48
1 Mar 2010
Burke S Keating C Walsh A O’Keefe D Kearns S
Full Access

Ankle intra-articular pathology after acute injury is common and often under-diagnosed. While the majority of soft tissue injuries improve with rehabilitation, up to 40% of patients experience chronic pain, stiffness or instability. MRI is increasingly used in the investigation of such patients; however interpretation of MRI findings requires specialist expertise. The aim of this study was to determine the diagnostic potential of magnetic resonance imaging (MRI) compared to ankle arthroscopy.

Forty consecutive patients presenting with ankle pain of at least three months duration were included in the study. This cohort of patients underwent magnetic resonance imaging (MRI) and then arthroscopy.

Pre-operative MRI reported findings were compared with the arthroscopic findings. The sensitivity, specificity, positive and negative predictive value of MRI for diagnosing ankle pathology was then assessed. The 2 senior authors reviewed the MRI scans and their findings correlated.

The average time between injury and presentation to our service was 2.2 years. This interval ranged from 3 months to 10 years. 51% of patients gave history of inversion and/or plantar flexion injuries. 14 % had symptoms, which persisted following an ankle fracture. At arthroscopic evaluation 23 patients had osteochondral defects and 37 had evidence of synovitis. MRI identified 50% of the osteochondral defects with sensitivity 50% and specificity 100%. Synovitis was not identified in any of the patients on preoperative MRI but 33% of the preoperative MRI did demonstrate a joint effusion.

Despite the high rate of discordance between MR imaging and arthroscopy in our study MRI still remains a useful adjunct in the investigation of ankle pain. The implications for practice and further study are discussed.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 53 - 53
1 Mar 2010
Keating C Colgan G O’Sullivan M
Full Access

Total Elbow arthroplasty can be a valuable treatment option in the painful or stiff elbow but outcomes have been disappointing previously. The history of total elbow arthroplasty has been disappointing in the past. Implants initially were a coupled articulation and were a rigid hinge. There was then a move to resurfacing type of designs although there was an issue with instability postoperatively with these implants. The semiconstrained coupled implant was developed in the mid 1970s by Coonrad. The idea behind the implant was that the loose polyethylene coupling provides inherent stability while decreasing the amount of loosening that was seen with the rigid hinge implants previously. We are reporting our results of our experience with a single type of semiconstrained implant that has been used in our unit since 1999.

A semiconstrained total elbow arthroplasty was performed in thirteen patients over a period of 7 years period in our unit. Mean age at time of surgery was 60 years (44–70) M:F ratio 11:2. The aetiology of the joint pathology was Rheumatoid Arthritis (n= 10), psoriatic arthritis (n= 2) & posttraumatic (n =1).

The patients were followed up for a mean duration of 4.5 years. They were assessed for range of motion, Mayo elbow function scores and radiographic evaluation and complication rate. 9 of the 13 elbows had a good to excellent result. There were 5 complications overall. There was two ulnar neuropathies that eventually resolved and one ulnar component that had to be revised 2 weeks after initial insertion. 3 had condylar fractures none of which required further operation. One patient had evidence of radiographic loosening but was asymptomatic.

In our experience the semiconstrained total elbow replacement is a valuable option in the treatment of painful stiff the elbow.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 48 - 48
1 Mar 2010
Keating C Burke S Walsh A Kearns S
Full Access

Abstract: Plantar fasciitis is the most common cause of heel pain for which medical care is sought. It is associated with significant morbidity placing activity limitations on the patients. The response of plantar fasciitis to any treatment is unpredictable. Many different modalities of treatment are used in its management. Injection of plantar fascia with local anaesthetic and steroids under general anaesthesia was carried out in 50 patients who had a clinical diagnosis of plantar fasciitis of greater than 3 month duration. Following induction of general anesthesia, a 20-gauge needle was guided toward and into the plantar fascia. 5mls of local anaesthetic and steroid was injected into the proximal plantar fascia. The patients were followed up over a mean of 6 months. Pain intensity was graded on an 11-point visual analog scale (VAS). Questionnaires with the VAS were filled out after treatment to determine the effectiveness of the procedure. The mean pain score decreased by 5.4 points. There were no complications during or after the procedure. Patients were questioned in relation to their occupational, athletic and recreational activities pre and post the injection.

Injection of the plantar fascia under general anaesthesia is a safe and effective method for the relief of conservatively unmanageable heel pain due to plantar fasciitis. A larger patient population and a greater than 1 year follow up would be helpful to determine the long term benefits & outcomes of this treatment.